Chobham and West End Medical Practice

Chronic Disease Practice Nurse

The closing date is 04 October 2025

Job summary

To be responsible for the implementation of processes for the effective management of patients with long-term conditions using evidence-based practice including care for elderly and housebound patients.

Working as a senior member of the practice multidisciplinary team, the post holder will ensure nursing services are delivered effectively to the entitled patient population.

The chronic disease practice nurse will be responsible for a number of clinical areas as well as actively supporting the management team in reviewing and delivery of clinical policy and procedure.

Main duties of the job

The following are the core responsibilities of the Chronic disease practice nurse.

Key Responsibilities:

To Support Infection Prevention Control

To develop, implement and embed an effective care management programme for the frail and housebound patients registered at the practice

To assess the needs of patients ensuring the provision of healthcare is appropriate.

To develop, implement and embed health promotion and wellbeing

To implement and evaluate individual treatment plans for chronic disease patients

To identify, manage and support patients at risk of developing long-term conditions, preventing adverse effects to patients health

Provide routine nursing care to patients in accordance with clinical based evidence

As required diagnose and manage acute and chronic conditions

To prescribe medication for patients in accordance with local formularies, national guidance and own scope of practice

To review patient medications to enhance compliance

To provide guidance to patients in the use of prescribed and over the counter medications regarding side effects and dosages

To co-ordinate the provision of travel medicine services

To request pathology services and process pathology results as required

To maintain accurate clinical records

To assist GPs with minor surgery when required

To support the team in dealing with clinical emergencies

To implement vaccination programmes for adults and children

About us

The Chobham & West End Medical Practice isa general practice with a main surgery in Chobham and a branch site in West End, both of which are purpose-built facilities.The practice provides general medical services to the local community.

The practice is a part of the NHS (National Health Service) and is regulated by theCare Quality Commission. The Chobham & West End Medical Practice is a relatively modern practice, with its main surgery in Chobham and branch site in West End, both being purpose-built facilities, as mentioned in theCare Quality Commissionreport.

Details

Date posted

04 September 2025

Pay scheme

Other

Salary

Depending on experience

Contract

Fixed term

Duration

1 years

Working pattern

Part-time, Flexible working

Reference number

A4478-25-0003

Job locations

16 Windsor Road

Chobham

Woking

GU24 8NA


Job description

Job responsibilities

The following are the core responsibilities of the Chronic disease practice nurse. There may be, on occasion, a requirement to carry out other tasks; this will be dependent upon factors such as workload and staffing levels.

Key Responsibilities:

To Support Infection Prevention Control

To develop, implement and embed an effective care management programme for the frail and housebound patients registered at the practice

To assess the needs of patients ensuring the provision of healthcare is appropriate.

To develop, implement and embed health promotion and wellbeing

To implement and evaluate individual treatment plans for chronic disease patients

To identify, manage and support patients at risk of developing long-term conditions, preventing adverse effects to patients health

Provide routine nursing care to patients in accordance with clinical based evidence

As required diagnose and manage acute and chronic conditions

To prescribe medication for patients in accordance with local formularies, national guidance and own scope of practice

To review patient medications to enhance compliance

To provide guidance to patients in the use of prescribed and over the counter medications regarding side effects and dosages

To co-ordinate the provision of travel medicine services

To request pathology services and process pathology results as required

To maintain accurate clinical records

To assist GPs with minor surgery when required

To support the team in dealing with clinical emergencies

To implement vaccination programmes for adults and children

Clinical Skills

Essential

Registered Nurse

Experience of working in a primary care environment

Wound care/removal of sutures and staples

ECGs

Ear syringing

Venepuncture

New patient medicals

Immunisations (routine, childhood and travel)

Womens health (cervical cytology, contraception, etc.)

Requesting pathology tests and processing the results, advising patients accordingly

Travel medicine

Chronic Disease Management

Diabetes

Hypertension

CHD

Asthma

Spirometry

Job description

Job responsibilities

The following are the core responsibilities of the Chronic disease practice nurse. There may be, on occasion, a requirement to carry out other tasks; this will be dependent upon factors such as workload and staffing levels.

Key Responsibilities:

To Support Infection Prevention Control

To develop, implement and embed an effective care management programme for the frail and housebound patients registered at the practice

To assess the needs of patients ensuring the provision of healthcare is appropriate.

To develop, implement and embed health promotion and wellbeing

To implement and evaluate individual treatment plans for chronic disease patients

To identify, manage and support patients at risk of developing long-term conditions, preventing adverse effects to patients health

Provide routine nursing care to patients in accordance with clinical based evidence

As required diagnose and manage acute and chronic conditions

To prescribe medication for patients in accordance with local formularies, national guidance and own scope of practice

To review patient medications to enhance compliance

To provide guidance to patients in the use of prescribed and over the counter medications regarding side effects and dosages

To co-ordinate the provision of travel medicine services

To request pathology services and process pathology results as required

To maintain accurate clinical records

To assist GPs with minor surgery when required

To support the team in dealing with clinical emergencies

To implement vaccination programmes for adults and children

Clinical Skills

Essential

Registered Nurse

Experience of working in a primary care environment

Wound care/removal of sutures and staples

ECGs

Ear syringing

Venepuncture

New patient medicals

Immunisations (routine, childhood and travel)

Womens health (cervical cytology, contraception, etc.)

Requesting pathology tests and processing the results, advising patients accordingly

Travel medicine

Chronic Disease Management

Diabetes

Hypertension

CHD

Asthma

Spirometry

Person Specification

Qualifications

Essential

  • Qualified NMC nurse

Desirable

  • Diabetes & Asthma
Person Specification

Qualifications

Essential

  • Qualified NMC nurse

Desirable

  • Diabetes & Asthma

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Additional information

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

Chobham and West End Medical Practice

Address

16 Windsor Road

Chobham

Woking

GU24 8NA


Employer's website

https://chobhamandwestend.nhs.uk/ (Opens in a new tab)

Employer details

Employer name

Chobham and West End Medical Practice

Address

16 Windsor Road

Chobham

Woking

GU24 8NA


Employer's website

https://chobhamandwestend.nhs.uk/ (Opens in a new tab)

Employer contact details

For questions about the job, contact:

Practice Manager

Sarah Roberts

sarah.roberts42@nhs.net

01276857117

Details

Date posted

04 September 2025

Pay scheme

Other

Salary

Depending on experience

Contract

Fixed term

Duration

1 years

Working pattern

Part-time, Flexible working

Reference number

A4478-25-0003

Job locations

16 Windsor Road

Chobham

Woking

GU24 8NA


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